cocainerelapse worksheets - dublin, · pdf file1 overview the cocaine relapse worksheetshave...

WorksheetsRELAPSECOCAINE

Overview

The Cocaine Relapse Worksheets have been developed by the SAOL Project inconsultation with local drug projects and services in the Dublin area. The need forrelapse intervention tools was identified by projects in the North Inner City DrugsTask Force area and an application to fund a range of cocaine responses was madeto the Dormant Accounts Fund by the SAOL Project. While the worksheets arespecifically targeted at cocaine users, they could be used effectively with otheraddictive behaviours by adapting the examples.

The worksheets are part of a range of three practical responses to cocaine use,including an Eight Week Reduce the Use Course for groups of cocaine users anda CD targeting individual users.

The Worksheets are designed to be used in one to one sessions between a clientand Key Worker. They are a practical, brief, intervention tool and not a replacementfor counselling or a longer term therapeutic relationship. A Key Worker with goodinter-personal skills, experience and training in addiction work should be wellequipped to work through them with their client.

Many local projects are helping clients through cocaine relapses on a regular basisby providing support, guidance and advice. These worksheets simply provide theworker and client with a practical framework to address their relapse.

Acknowledgements

We would like to thank everyone who assisted us in developing all of the cocaineresources but especially the following:

North West Training & Development Project, Citywide Drugs Crisis Campaign, YouthAction Project, SNUG Counselling, Ana Liffey Drugs Project, Star Ballymun, HSERehabilitation Integration Services, Addiction Counsellors, HSE Addiction Services,Dublin Aids Alliance, Crosscare, Chrysalis, HOPE, After Care Recovery Group, StarBallyfermot, SOILSE, Crinan Project, Canal Communities Local Drug Task Force,North Inner City Drugs Task Force.

To the Key Workers and clients that helped us to trial and refine the worksheets wewould also like to say thank you.

For more information on the resources go to: www.saolproject.ie

INTRODUCTION TO THE WORKSHEETS

This booklet contains instructions for the Key Worker and worksheets for the client.This booklet is your Project’s Resource and is intended to be used over and overagain. You should photocopy the Worksheets, Cravings, Information Sheet and DrugDiary Sheets.

DO NOT WRITE ON THE ORIGINAL WORKSHEETS PHOTOCOPY BEFORE USE

What will these Worksheets do?

They will provide you and your client with a helpful, structured interventiontool to address a cocaine relapse.

They will help your client to identify what problems cocaine is causing them

They will help your client recognise what triggers them into using cocaine

They will help your client plan to avoid these triggers

They will assist your client to gain a better understanding of why they haverelapsed

They will assist your client to learn how to develop refusal skills and avoidfuture relapses

Why use Worksheets?

Giving your client pre-formatted worksheets helps to focus both you and yourclient on the task in hand

They focus on the immediate problems faced by cocaine users who arestruggling to control their drug use.

They are a brief intervention tool and are therefore well suited to projects withlimited resources

They are practical and easy to understand

They are compatible with a range of other treatments which your client maybe receiving

The worksheets provide a written record for later reflection by your client intimes of crisis or relapse

WHAT IS EXPECTED OF YOU – THE KEY WORKER?

You should ensure that you have the addiction skills and experience to workwith your client through his/her relapse.

You should ensure that you have fully familiarised yourself with theWorksheets and instructions before using them.

You should ensure that you have allocated the appropriate, uninterruptedtime with the client (usually a minimum of three one hour sessions –maximum six sessions)

Aim for each session to be approx 45 minutes long. This is flexible but as ageneral rule anything longer than one and a half hours is too long.

If your client has literacy difficulties you should be prepared to be the scribefor the worksheets. Use your clients own words and write down theirreflections, situations and plans.

You should ensure that your client does not leave any sessions withoutmaking a Relapse Action Plan for the immediate day(s) ahead. This can be averbal agreement between you and your client or you could use W3.

You should encourage your client at all times and make sure that they get themessage that they CAN do this.

You should ensure that you have adequate information and resources tofollow up with the process if necessary, e.g. referrals to otheragencies/counselling etc.

You should ensure that you, or your project, are available to your client for areasonable amount of support and follow up work after completing theWorksheet intervention.

What is expected of your client?

Your client should be motivated and have expressed a wish to overcome theirrelapse.

Your client should be prepared to work through the Worksheets over an agreednumber of sessions with you.

W1INSTRUCTIONS FOR WORKSHEET ONEPROBLEMS WITH USING COCAINE

Aim: To help your client explore the problems that their cocaine use iscausing them.

Client fills in Worksheet One. To encourage honesty, you could prompt them with the following questions

Do they owe money? Have they picked up any new charges?

Has their health gotten worse recently?

Has their use of other drugs (including alcohol) increased?

Are they having family or relationship problems because of their cocaine use?

Are they paranoid or aggressive?

Discuss the Wheel of Change with your client. Explain each of the six stages and askyour client where they place themselves on the wheel. This exercise will help yourclient determine if they are ready for change now.

When your client has completed Worksheet One, use the information as a focus for further discussion. Ask them to reflect on the following:

Can they continue to go on this way?

Do they want to change things?

Are they ready to make these changes now?

If you are satisfied that your client has reached a point where they want to address theircocaine use, then proceed. If your client has serious doubts at this stage about theirreadiness or commitment to stopping their cocaine use, please continue to set timeaside for further discussion and encourage your client to take some more time to reflect.In this case, you may want to give your client a copy of the Cocaine CD which isincluded in your Cocaine Resource Pack. Additional copies of this CD can bedownloaded from the website www.saolproject.ie

Always keep ‘the door open’ letting your client know that you will be here when they areready for the next step.

Get your client to fill in the Drug Diary before your next meeting. This will help you toidentify patterns and trigger situations.

Step 2

Step 3

Step 4

Step 1

INSTRUCTIONS FOR WORKSHEET TWOIDENTIFYING TRIGGERS

Aim: To help the client understand what a drug use trigger is and to helpthem begin to identify their own personal triggers.

Explain to your client that a trigger is like the spark that lights the flame. It is themoment when they find themselves in a situation that ignites their ‘thoughts’ of cocaineinto actually using the drug again. Remind them that these thoughts may have been intheir head for many days/weeks/months before they actually used. By getting your clientto recognise their triggers they are taking the first step towards making a plan to avoidor get out of their relapse.

Triggers can be grouped around People, Places, Things and Feelings. Using WorksheetTwo ask your client if they can identify what may have triggered off their cocaine use.The following examples may be useful:

People: partners, family members, friends, neighbours, etcPlaces: particular streets, pubs, cafes, houses, clinics, parks, etcThings: music, tinfoil, works, etcFeelings: boredom, loneliness, happiness, sadness, grief, etc

Please remember that your client may identify triggers such as the fact that they areliving with a partner who is using and can see no immediate way to deal with this.Remember you should concentrate on what CAN be achieved in the short term, but yourclient will need to do some further thinking on the more difficult issues, such asrelationships.

Use the information they have provided to discuss how they will avoid their triggers

Use what the client has given you to prompt discussion and the beginnings of a plan.You will need to identify what supports they will need over the coming days.

This is the beginning of your client’s Relapse Action Plan and it is very important tospend some time discussing this with them. If they make any concrete decisions, getthem to write them down in Worksheet Three (My Relapse Action Plan).

Step 1

Step 2

Step 3

W3INSTRUCTIONS FOR WORKSHEET THREERELAPSE PLAN ACTION PLAN

Aim: To help your client plan how to avoid their triggers and to put a Relapse Action Plan in place

Review the information your client has already written about their triggers. Get yourclient to talk about the various triggers they have identified and to see which triggersare obvious (e.g. hanging around with others who are using cocaine) and which onesare unexpected (e.g. bumping into someone on the street). Using Worksheet Three,prompt your client to name their trigger and identify a plan to avoid it. You may want totalk about the difference between obvious triggers and unexpected triggers. You mayneed to challenge your client if they are putting themselves in the way of their triggersand allowing themselves to believe that they don’t have any control over this.

Some prompters:

Do they need to get a new chip for their mobile phone?

Are there people in their life that they should avoid and how are they goingto do this?

What other services or supports can they make contact with?

Do they need to get rid of certain items around them which remind them ofusing?

Road test the plan with the client to ensure it is clear, realistic and achievable. Do thisby asking questions or role play some situations if you think it would be helpful.

Step 1

Step 2

INSTRUCTIONS FOR WORKSHEET FOUR REFUSAL SKILLS

Aim: To help your client identify and practice their refusal skills.

Often clients will find it difficult to imagine themselves refusing coke. To work throughthis ask your client to think about any situation from the past when they refused cocaine.If your client says that they haven’t been able to say no in the past ask them if everytime they had a craving, did they go out and use? It would be near impossible forsomeone to use coke every time they experience a craving so the chances are that theyhave used some form of refusal skills in the past but that they were not aware of it.

Discuss the kind of refusal skills they may use in different situations. Raise thefollowing points:

They need to be direct, assertive and make eye contact with the person. There isno need to be aggressive or confrontational.

Close off any future offers of cocaine i.e. tell the dealer that they have given upcoke for good.

If they can’t refuse face to face, possibly a phone call or a text message would do.

If the client does not feel comfortable in refusing directly they may want to use anexcuse and leave the situation i.e. say that they are in trouble with some authority i.e.courts, social workers, drug treatment clinic etc.

Make sure your client writes down the various refusal ideas they have come up with asit will help them remember them in the future. Role play or discuss various situationswith your client until he/she feels comfortable with their refusal skills. If you feel thatyour client is being unrealistic or negative you may need to respectfully challenge them.

Step 1

Step 2

Step 3

W5INSTRUCTIONS FOR WORKSHEET FIVECOPING WITH CRAVINGS – CRAVINGS DIARY

Aim: To help the client recognise, record and deal with cravings.

Using Worksheet Five Information Sheet “Understanding Cravings”, explain to yourclient how cravings are a normal part of the recovery process. Give your client aphotocopy of the W5 information sheet. Discuss how your client will deal with theircravings.

Explain the Cravings Diary to your client. Ask them to take it home and write about theircravings when they experience them. This helps in two ways:

Firstly, it gives the client something to focus on when the craving kicks in.

Secondly, it empowers the client to listen to their own body and begin to takecontrol over the physical and emotional cravings the drug produces.

Step 1

Step 2

W6INSTRUCTIONS FOR WORKSHEET SIXRELAPSE WARNING SIGNS

Aim: To help your client identify their relapse warning signs in order to preventfurther relapses in the future.

Discuss Information Sheet (W6i) with your client – Common Warning Signs.

Explain the concept that prior to a relapse people will often choose to ignore theirrelapse warning signs until it is too late and they begin using again.

Give your client Worksheet Six and get them to identify their own personal relapsewarning signs. If your client is to avoid having any further relapses in the future, theywill need to heighten their awareness of their warning signs so they can interruptthem before it turns into an action i.e. a relapse.

Get your client to list interventions that they can put into action to help them preventrelapsing when they notice their warning signs. Remember that these need to bepractical and achievable. You should challenge your client if they have identified anyunreasonable, unrealistic interventions. Your client should have an intervention foreach warning sign that they listed.

Your client should carry this information around with them at all times so they canlook at it from time to time. If they maintain their heightened level of awarenessaround their warning signs they have a better chance of avoiding relapses in thefuture.

Step 1

Step 2

WORKSHEET ONE:

PROBLEMS WITH USING COCAINEW1

What problems is my cocaine use causing me?

Health

deterioration

Police

Charges

Increase in other druguse, especially

alcohol No dailyroutine

Paranoia and aggression

Housing under

threatFamily and

Relationship Problems

Sleeplessness andloss of

appetite

This exercise is designed to get you to start looking at the problems that your cocaine use is causingyou. Please take your time with this, as this is an important first step in your efforts to take back yourself control. Below are some things that have been mentioned by other cocaine users. They might helpto get you thinking. Write your own list in the space provided:

Relapse

has relapsed to

drug use

PRECONTEMPLATIONdoes not recognise theneed for change or is notactively consideringchange

CONTEMPLATIONrecognises problemand is consideringchange

PREPARATIONis getting readyto change

ACTIONis initiatingchange

MAINTENANCEis adjusting to changeand is practicing newskills and behavioursto sustain change

PRECONTEMPLATIONThis stage is when a person either does notrealise they have a problem or has no desireto make changes in their lives.

CONTEMPLATIONThis stage is when someone is starting tothink about their addiction and thepossibility of making changes in their lives.

PREPARATIONThis stage is when someone makes thedecision to make changes in their lives andputs plans in place to make this a reality.

ACTIONThis stage is when someone has decided tomake some changes and starts toimplement the actions necessary to achievetheir goals of being drug free.

MAINTENANCEThis stage is when someone continues tomodify behavioural changes in order tomaintain their recovery.

RELAPSEThis stage is when someone goes back todrug using behaviour.

It is important to state that clients can goaround the wheel many times when workingon their own recovery. It is for this reasonthat relapse can be seen in the context of astage of a person’s recovery as they willlearn new insights into their addictivebehaviour and can focus on the reasons fortheir relapse before getting back on thewheel.

WORKSHEET 1.1:

WHEEL OF CHANGE

WORKSHEET TWO:

IDENTIFYING MY TRIGGERSThis exercise is designed to help you identify your personal triggers orrisk factors. Please use the reverse side of the worksheet if you needto.

PEOPLE: What people trigger myrelapse?

PLACES: What places do I go to thattrigger my relapse?

THINGS: What things trigger myrelapse?

FEELINGS/EMOTIONS: Whatemotions trigger my relapse?

dn’t

idn’

WORKSHEET THREE:

MY RELAPSE ACTION PLANExamples:

Are there people that I need to break ties with? If so, what do I need to do to avoid them?

Are there people I know who use or supply cocaine? If so, what do I need to do to avoid them?

Are there things that remind me of cocaine use? If so, what do I need to do to get rid of them?

Are there places that remind me of cocaine use? If so, what do I need to do to avoid them?

How much money should I carry out with me in order to reduce the possibility of buying cocaine?

How can I protect myself against certain people/feelings that may trigger my drug use?

What’s my trigger? What’s my plan to avoid it?

If you need more space, use the back of the sheet.

WORKSHEET FOUR:

MY REFUSAL SKILLSThis worksheet will help you think through how you will refuse offers of coke.What do you need to say? What do you need to do? If it helps, role play somesituations with your Key Worker. Remember the clearer you are, the clearer youwill get your message across to others who may be encouraging you to use.

LIST SOME SITUATIONS WHERE YOU WILL NEED TO REFUSE COKE

LIST HOW YOU WILL REFUSE IN THESE SITUATIONS

ng. Th

ing’

Talking about cravingsA very effective way of getting through a craving is to make contact with someone whounderstands what you are going through. Do you know someone you can trust and talkto? Can you phone someone? Can you contact your Key Worker?

Going with the cravingIt can be a very empowering, positive experience to let the craving occur, peak andpass. In other words, experience it without fighting or giving in to it. Imagine you arewalking over a hill. Its tough going up but you know you will shortly reach the top andcome down the other side. Listen to the craving, focus on how intense it is and whereit occurs in your body. If you find it useful, fill this information into your Craving Diary.

Think about the negative consequences of using cocaine againMany people tend to remember only the positive effects of cocaine: they often forgetthe problems that cocaine use brings with it. Worksheet One asked you to make a listof the problems you were experiencing with cocaine. Read your list again. If you cannotfind them, re-do your list. Remind yourself, very strongly, of the negative consequencesof using again.

WORKSHEET 5.1: INFORMATION SHEET

Understanding CravingsCravings are a normal process and are to be expected. They will come and go and aremost often experienced early in recovery but can persist longer. Cravings can betriggered in many ways:

Seeing someone that you associate with cocaine use

Emotions such as frustration, stress, boredom, depression, excitement,happiness, etc

Familiar objects, smells and sounds

Physical signs of Cravings can include: Feeling nervous and agitated

Heart pounding

Sensation of being able to smell or taste the drug

Sweaty palms

Feeling of wanting to go to the toilet/diarrhoea

Psychological signs can include: Fantasies about using

Convincing yourself that you’ll feel great if you use

Fooling yourself that it’ll be ok to use just the once

There are a variety of ways that you can cope with cravings.

DistractionFind something to take your mind off the craving. Make a list of the things that are possible to do.

WORKSHEET SIX: INFORMATION SHEET

COMMON WARNING SIGNS

Changes in Behaviour Hanging out with people who use

Not going to rehabilitation programmes or support groups (such as NA/AA)

Taking other drugs including alcohol

Arguing with others for no apparent reason

Not being honest with those around you

Doing things that are self destructive, i.e. shoplifting, hanging out with peoplethat make you feel bad

Not filling your days and spending a lot of time feeling bored

Changes in Attitude Not caring about yourself

Becoming really negative about life and how things are going

Going Back to Your Old Ways of Thinking Thinking that you deserve a reward for being clean for a period of time

Thinking that you could just have one bag and that it would be alright

Thinking that you are ‘cured’ and you no longer need to be careful of your triggers

Changes in Feelings or Moods Feeling unusually stressed

Feeling depressed or angry

Feeling invincible and unusually happy

WORKSHEET 6.1:

RELAPSE INTERVENTION

PART 1 – Your Relapse Warning Signs

i.e. Stopped going to NA meetings. Was feeling really angry with everyone around me. Was thinking negative thoughts a lot of the time. Starting avoiding my family. Fantasised about using as a reward.

__________________________________________________

PART 2 – What to do when you notice yourwarning signs – Relapse Interventions

i.e. Make myself speak to my sponsor. Talk to a counsellor about my feelings of anger. Take some time out to do something for me. Open up to someone I trust about my feelings.

__________________________________________________

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